Personalized Security File Request for Praxis™ 9s

We offer an activation service for all those users of the Freely Distributed Medical Software Praxis™ that would like to personalize the program's printouts bearing their personal data and/or logo.

There are 3 parameters needed for the personalization of the program printouts. The rest of the parameters in the form below refer to the way we can get in touch with you and the delivery address to send the Personalized Security File. The fields with a star, (*), are compulsory. The main 3 parameters are:

1. Your Full Name and Title, in any sequence order of your choice, (see the note that follows)
2. The Name of Your Practice
3. Your Medical Association Number or VAT Number .

Note

You decide the order of the name that will appear on the printouts. That is if your first name follows your surname and vice versa. The same applies for your title, (if any).

The way to Issue and Deliver the Personalized Security File to You

• You will be contacted as soon as we receive your request for the time and place of the delivery.
• Our Courrier will hand deliver the Personalized Security File on a CD and he will collect our €50 service fee plus the courrier's expenses.

Request Form

Surname, (*):
First Name, (*):
Title:
Name of Medical Practice , (*):
Med. Assoc. or VAT Number, (*):
Your Medical Speciality :
Praxis™ Module:	Odon™ (Dentists) Orthon™ (Orthodontists) Therapon™ (General Practitioners) Physion™ (Physiotherapists)
Delivery Address , (*):
Postal Code , (*):
Town, (*):
Country, (*):
Telephone, (Land Line) , (*):
Mobile:
e-mail, (*):
Name Sequence Order :	(Title) - Surname - First Name (Title) - Name - Surname Surname - First Name - (Title) First Name - Surname - (Title)